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Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic.
Methods
This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters.
Results
Simultaneous health system resource reallocation was associated with increased mortality in multivariate models (b = 0.80, 95%CI 0.42-1.18). However, preemptive (previous month’s) resource reallocation was protective against excess mortality (b = −0.58, 95%CI −0.93–0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality.
Conclusions
In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.
The US major-party presidential nominating conventions are an essential platform for a political party’s branding and messaging for upcoming presidential and congressional elections. The conventions also can provide revenue and media attention to their host cities and, consequently, convention fundraising has grown substantially in recent decades. Convention fundraising rules were changed in 2014, tripling the limit for contributions to a party’s campaign funds and removing limits on contributions to host-city committees. Although we do not expect these changes to affect individual donors, we expect corporations, banks, and labor unions to have taken advantage of these new rules. Elections since 2014, however, have been unusual in many ways—for instance, in the relationship between the nominees and their parties and, in 2020, the public health precautions required to hold conventions. This study examines developments in political-party convention fundraising since 2014, focusing on the relationships among candidates, their parties, and the cities where conventions have been held. To make this determination, funding reports were collected for the 2000–2024 election cycles. The article explores changes in the characteristics of convention donors—their other contributions and their relationships to candidates, party committees, and host cities—and notes variations that might be attributable to the nominees or the host cities. It considers whether the new convention-funding rules have matured sufficiently that it is possible to make broad claims about the effects of the rules themselves.
People living with dementia (PLWD) want – and have the right – to participate in research that impacts them. However, barriers in legislation, institutional practices, and/or biases may jeopardize inclusion.
Objective and Methods
Interviews with 33 Canadian dementia researchers were conducted to explore understandings of research consent with regard to dementia, research practices, and approaches in everyday research contexts.
Findings
Analysis of these interviews revealed challenges in negotiating the space between best practices and institutional requirements; gaps in knowledge, procedures, and guidelines on inclusion and consent; tensions regarding who should be involved in decision making; and how assumptions of presumed incapacity and/or the ‘protection’ of vulnerable groups create and/or sustain the exclusion of PLWD from research.
Discussion
Moving forward, findings suggest that advancing the meaningful inclusion of PLWD in Canadian dementia research will require clear, consistent standardized guidelines, flexible and ongoing consent processes, accessibility accommodations, and a stronger focus on rights-based practices.
Design optimisation of hybrid airships consisting of multi-lobed configurations is being projected as the next paradigm shift in implementing sustainable flight operations within the aeronautical industry. To that end, this paper discusses the effect of varying the relative placement of side-lobes pertaining to a tri-lobed airship hull geometry with respect to the middle-lobe. The paper makes use of a validated OpenFOAM® solver to underscore the aerodynamic impact of shifting the side-lobes in upstream, downstream, upward and downward directions with respect to the middle-lobe while retaining the same volume. These tri-lobed airship hull variants called as skewed tri-lobed hulls, have been comprehensively investigated through the usage of numerical solver (Reynolds-averaged Navier-Stokes) at high Reynolds number flow across various angles of attack. The investigations delineate significant impact of skewed side-lobes on the overall aerodynamics of the tri-lobed airships. Skewing the side-lobes in fore direction leads to drag mitigation at the expense of degraded aerodynamic efficiency owing to lift reduction. Contrarily, aft-skewness amounts to an aerodynamic efficiency enhancement of $ \approx 17{\rm{\% }}$ and improved pitch stability while marginally increasing the pressure drag liability. Aerodynamic efficiency enhancement is attributed to increased lifting force. Skewed upward and downward variants present an overall aerodynamic efficiency reduction. The paper further made use of detailed flow-field visualistion as well as pressure-coefficient distribution plots to underscore the underlying flow-physics related to aforementioned aerodynamic trends. These investigations emphasised the presence of varying three-dimensional relieving effect, intermixing between the three lobes as well as diverse flow separation characteristics downstream of the maximum diameter region leading to the aerodynamic variations thereof. The paper enhances aerodynamic understanding related to tri-lobed geometry that will be crucial in implementing future design changes to the baseline model for improved aerodynamic performance. Amalgamation of these inferences with an optimisation scheme could be implemented in future aerodynamic investigations to optimise tri-lobed geometry for enhanced aerodynamic utility.
There is limited data describing statewide pediatric surge response during times of capacity strain.
Objective
Characterize the burden and response to a surge in pediatric respiratory admissions in Oregon in 2022.
Design, Setting, and Participants
This analysis utilized data from the Oregon Capacity System (OCS) and the state discharge database to describe patient characteristics, census changes, and admission pattern shifts during an RSV epidemic in 2022.
Main Outcome and Measure
Statewide pediatric census, weekly pediatric admissions, weekly admissions from non-children’s hospital emergency departments (EDs) to non-children’s hospitals.
Results
The median census in Oregon’s pediatric inpatient hospitals increased by 19% during the surge period (306 vs 364, P < 0.001), while the median pediatric intensive care unit census increased by 50% (24 vs 36, P < 0.001). Weekly elective pediatric admissions to children’s hospitals decreased by 33% (30 vs 20, P = 0.03). ED admissions to non-children’s hospitals increased by 160% (15 vs 39 per week, P = 0.02).
Conclusion and Relevance
As the statewide pediatric inpatient census increased, targeted reductions in elective admissions and increased utilization of non-children’s hospitals increased capacity during a respiratory surge. This analysis underscores the importance of real-time situational awareness and coordinated surge response between hospitals.
In recent years, we have seen an immense expansion in recombinant DNA, especially in its use in gene therapy applications. Throughout its history, the United States set up several mechanisms of national safety and ethical oversight for rDNA to ensure that we proceeded with its use appropriately. As our knowledge and experience with it grew, there has been increasing pressure to decrease the oversight and monitoring requirements for its use. In 2019, the National Institutes of Health amended the NIH Guidelines for Research Involving Recombinant DNA Molecules eliminated three national mechanisms for guidance, monitoring, and review of this biotechnology. Four years later, we revisit these changes and their implications for a current emerging biotechnology: xenotransplantation. By better understanding the motivations for these mechanisms and analyzing the test case, we argue that these changes have worrisome implications for our ethical oversight of emerging biotechnologies both in the realm of gene transfer technologies and beyond.
A new sponge species (Demospongiae: Poecilosclerida: Podospongiidae) is described offshore from the Cape of Good Hope, on the southern edge of the Table Mountain National Park marine protected area. Podospongia capensis sp. nov. is compared to Podospongia natalensis, described by Kirkpatrick (1903) from the east coast of South Africa, as well as to all other Podospongia species described to date. The new species differs from P. natalensis in having a shorter, thicker stalk, lacking anisostrongyles as megascleres, and possessing a second category of large symmetrical aciculospinorhabds microcleres that are present in P. natalensis. Additionally, P. natalensis has larger oxeas and styles than those found in P. capensis sp. nov. Furthermore, the two species are geographically separated, with P. natalensis described from the Natal ecoregion, while P. capensis sp. nov. is described from the Southern Benguela ecoregion. The new species primarily differs from other congeners in external morphology and size of the oxeas and styles.
Fruit flies are the most serious problem in fruit production worldwide, causing severe losses in production and fruit quality. The use of parasitoids, especially Diachasmimorpha longicaudata (Ashmead) (Hymenoptera, Braconidae), is an important tool for suppressing the fruit fly population. The objectives of this study were to determine the exposure time, density, and ideal larval instar of Ceratitis capitata (Wiedemann) (Diptera: Tephritidae) and to verify whether the parasitoid’s previous experience affects its interaction with the host insect and the influence of these factors on the parasitism rate. In three bioassays, fly larvae were placed in ‘parasitism units’ to test different methods of exposure to female parasitoids. The variables included the previous experience of the female parasitoid with oviposition, the exposure time (30, 60, 120, 240, and 480 min) of the larvae to the parasitoid and the number (5, 10, 15, and 20) and instar (second and third) of the fly larvae. The flies and parasitoids that emerged were quantified, and the parasitism rate and sex ratio of the parasitoids were calculated. The results of the present study indicate that to increase the parasitism rate of D. longicaudata, third-instar larvae of C. capitata must be grouped into parasitism units of 20 larvae and exposed to a single female of the parasitoid for 8 h.
This study provides the description of a new species of Anisakidae, Contracaecum cocoi sp. nov., as well as the record of Contracaecum jorgei, both species parasitizing the Cocoi heron Ardea cocoi (Ardeidae) in a locality from the Buenos Aires Province, Argentina. An integrative taxonomic approach was used, involving phylogenetic analyses and the examination of diagnostic morphological features in the studied specimens. Among other features, the new species can be morphologically distinguished by the papillae arrangement on the male tail: while C. jorgei exhibits a simple morphotype A, C. cocoi sp. nov. presents an intermediate morphotype B. Mainly, the possession of three adcloacal papillae pairs is a diagnostic feature separating this new species from the rest of the Contracaecum species. The cox2 mtDNA isolates exhibited C. cocoi sp. nov. as a single node and grouped close to the clade formed by both species Contracaecum micropapillatum and C. bancrofti. The other cox2 mtDNA sequences showed a great concordance with C. jorgei. The K2P distances calculated for the cox2 mtDNA isolates of C. cocoi sp. nov. displayed a distance of 0.12 with C. bancrofti, 0.13 with C. micropapillatum, and 0.16 with C. jorgei. Contracaecum cocoi sp. nov. is proposed as a new taxon clearly supported by both phylogenetic analysis and distinctive morphological features that distinguish it from its congeners. The occurrence of C. cocoi sp. nov. together with C. jorgei in sympatric and syntopic conditions suggests that ecological or reproductive isolating mechanisms may be acting to maintain distinct lineages in shared environments. New records, particularly those involving intermediate and definitive hosts, will contribute to elucidating the distribution of these parasites in the Americas and potentially lead to the discovery of new species.
As a racialized group that is subject to discrimination, US Latinxs are often considered “natural” coalitional partners for Black-led civil rights struggles. Although the BLM movement may serve as a potential site for cross-racial coalition building because both Latinxs and Blacks suffer from racial profiling by law enforcement, the development of a shared status across group boundaries hinges on the interpretation by Latinxs of both their personal- and group-level discrimination experiences. Using the 2020 CMPS, I explore how multiple dimensions of Latinx racial group consciousness (perceptions of discrimination, intra- and intergroup commonality, and racial identity) shape their cross-racial alliances with Black social movements. Results from multivariate analysis show that Latinxs who acknowledge Black Americans’ continued struggle against racial discrimination in both American society and the Latinx community are positively oriented toward the BLM movement. Findings also reveal contrasting effects for inter- and intragroup commonality: the former is strongly and consistently predictive of increased support for the BLM Movement, whereas the latter is associated with decreased support. These findings underscore both the opportunities and challenges for Latinx–Black political coalition building.
A combined experimental and numerical investigation was conducted to examine the mechanisms of aerodynamic noise reduction for twisted hexagonal cylinders at Reynolds numbers ($ \textit{Re} = 2\times 10^4$–$10^5$) and twist angles per unit span $\gamma ^*\in \mathbb{R}[0,1/3]$. It reveals a non-monotonic dependence of noise reduction on $\gamma ^*$, optimised for $\gamma ^* = 1/6$, where a tonal noise reduction of 15 dB and a total sound reduction of 11 dB at $ \textit{Re} = 2\times 10^4$ were achieved. This was consistent across all Reynolds numbers tested. Additionally, dual tones were observed in the noise spectra for cases with $1/18\leqslant \gamma ^* \lt 1/6$, leading to the identification of two distinct flow patterns (Pattern I and II) based on the number of tones in the spectrum. Large-eddy simulations were performed at $ \textit{Re} = 2\times 10^4$ to support the acoustic measurements. Spanwise variations in flow separation gave rise to two distinct regimes: separation (RI) and reattachment (RII). For Pattern I ($1/5.4 \leqslant \gamma ^* \leqslant 1/3$), the spanwise variation of shear layer separation induced wavy vortex shedding, contributing to a moderate noise reduction. For Pattern II ($1/18 \leqslant \gamma ^* \leqslant 1/7.2$), differences in vortex shedding frequencies between RI and RII regimes led to vortex dislocation, forming C- or X-type vortex structures. The $\gamma ^* = 1/6$ configuration leads to a transitional pattern between Pattern I and II, where modulation was predominantly observed in the RI regime. The superior noise reduction of $\gamma ^* = 1/6$ stems from the combined effects of frequent vortex dislocation and modulation, which reduces spanwise coherency and increases wake three-dimensionality.
Balister, the second author, Groenland, Johnston, and Scott recently showed that there are asymptotically $C4^n/n^{3/4}$ many unordered sequences that occur as degree sequences of graphs with $n$ vertices. Combining limit theory for infinitely divisible distributions with a new connection between a class of random walk trajectories and a subset counting formula from additive number theory, we describe $C$ in terms of Walkup’s number of rooted plane trees. The bijection is related to an instance of the Lévy–Khintchine formula. Our main result complements a result of Stanley, that ordered graphical sequences are related to quasi-forests.
To investigate the variations of serum ghrelin levels in children with left-to-right shunt CHD, and analyse the correlation with the geometric structure of the heart. It may provide some clinical guidance for evaluating the early changes of cardiac structure and function in CHD children.
Methods:
A total of 93 children with left-to-right shunt CHD who were hospitalised to Children’s Hospital of Soochow University from September 2021 to February 2023 were included in the CHD group (of which 58 were ventricular septal defect and 35 were patent ductus arteriosus). In addition, 57 cases (mainly inguinal hernia) were selected as the control group. The corresponding clinical data were recorded, and the fasting serum ghrelin levels of the two groups were detected by enzyme-linked immunosorbent assay on the day of admission. Then, the clinical data and serum ghrelin levels of the two groups were compared, and the Spearman correlation was analysed.
Results:
The serum ghrelin level in CHD group was higher than that in control group, and the difference was statistically significant (P < 0.05). Z score of weight for age and Z score of height for age in CHD group were lower than those in control group were statistically significant difference (P < 0.05). But there was no correlation between serum ghrelin and BMI, weight-for-age Z-score, and height-for-age Z-score (P > 0.05). Ghrelin in the enlarged heart group was lower than that in the non-enlarged heart group, and there were statistical significance of among those groups (P < 0.05). There were no significant differences in left ventricular ejection fraction and left ventricular fractional shortening among different cardiac load groups (P > 0.05). The left ventricular end-systolic diameter Z-scores, left ventricular mass Z-scores, left ventricular mass index, and left ventricular end-diastolic volume-scores in the cardiomegaly groupwere higher than those in the non-cardiomegaly group, and those two groups were significantly different (P < 0.05). The relative wall thickness and left ventricular remodelling index in the cardiomegaly group were lower than those in the non-cardiomegaly group, and the differences between the groups were statistically significant (P < 0.05). Serum ghrelin was negatively correlated with left ventricular end-diastolic diameter Z-scores, left ventricular end-systolic diameter Z-scores, and left ventricular end-diastolic volume Z-scores in cardiac indexes (P < 0.05), positively correlated with left ventricular remodelling index (P < 0.05), and had no correlation with relative wall thickness, left ventricular mass Z-scores, and left ventricular mass index (P > 0.05).
Conclusion:
The levels of serum ghrelin are increased in CHD children, and serum ghrelin is negatively correlated with left ventricular end-diastolic diameter and left ventricular end-diastolic volume in cardiac geometric structure, and positively correlated with left ventricular remodelling index. Additionally, patients with cardiac enlargement present with a low serum ghrelin level. These findings collectively suggest that serum ghrelin may play a potential role in cardiac remodelling.